Provider Demographics
NPI:1851697122
Name:QUEZADA, VANESSA (PHARMD)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:QUEZADA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 POTRERO AVE
Mailing Address - Street 2:SFGH GENERAL MEDICINE CLINIC, 1M-3
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-3518
Mailing Address - Country:US
Mailing Address - Phone:415-206-8978
Mailing Address - Fax:415-206-5857
Practice Address - Street 1:1001 POTRERO AVE
Practice Address - Street 2:SFGH GENERAL MEDICINE CLINIC, 1M-3
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3518
Practice Address - Country:US
Practice Address - Phone:415-206-8978
Practice Address - Fax:415-206-5857
Is Sole Proprietor?:No
Enumeration Date:2011-02-04
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH61923183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist